Provider Demographics
NPI:1063836021
Name:PUTNAM, RAFAEL (RT/R)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:M
Credentials:RT/R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 NW PINE CONE DR
Mailing Address - Street 2:#103
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-8663
Mailing Address - Country:US
Mailing Address - Phone:505-307-4798
Mailing Address - Fax:
Practice Address - Street 1:2700 NW PINE CONE DR
Practice Address - Street 2:#103
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8663
Practice Address - Country:US
Practice Address - Phone:505-307-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600620422471C1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C1101XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiovascular-Interventional Technology